E-360 Edition 20: Questions and Answers

A: With a focal seizure, the seizure activity stays in one part of the brain. Therefore, you tend to have localised (focal) symptoms which appear quite subtle in some people. Different parts of the brain control different functions and depending upon which areas of the brain are affected will determine the outward signs of the seizure activity.

Two main types of focal seizures include:

Focal aware seizures

In this type of seizure, you do not lose consciousness or awareness. They may involve muscular jerks or strange sensations in one part of the body. Or you may hear, see, smell, or taste odd sensations. Some people develop pins and needles in one part of the body. These seizures are usually very brief lasting just a few seconds, but sometimes minutes. These can lead onto focal impaired awareness seizures or tonic clonic seizures.

Focal impaired awareness seizures

During this type of focal seizure, you are not aware of your surroundings or what you are doing. In effect, you have a partial loss of consciousness or awareness. Symptoms vary greatly but can include confusion, wandering, fidgeting, vocal sounds or confused language and chewing or lip smacking. These can also lead on to tonic clonic seizures.

Some people may call these seizures silent seizures, but this is not a recognised name for focal seizures. They were previously called partial seizures.

Q: How is nocturnal epilepsy treated? I am having seizures when I am asleep.

A: Nocturnal seizures are treated with medication like other types of epilepsy. The dosages of medication may be higher in the evening than during the day, and usually the medication is in the form of controlled release tablets, which means they release the medication slowly to keep the blood levels stable overnight.

Any form of epilepsy where the seizures are not controlled should be reviewed by a neurologist, and medication doses or the medication type may need to be changed. Two in three people will get good seizure control with medication. If, after a good trial of medications, the seizures are still not controlled other forms of treatment such as surgery or vagus nerve stimulation may be considered especially if the seizures are affecting quality of life.

Q: I was wondering what the chances are of a small bright light source near my work space causing a seizure?

A: We all find flickering lights or some colours or patterns irritating or difficult to look at to some degree however some people with epilepsy have seizures triggered by flashing or flickering lights, or by certain geometric shapes or patterns. People who have these seizures are diagnosed with photosensitive epilepsy.

Photosensitive epilepsy is a type of epilepsy we call reflex epilepsy and is seen in less than 5% of people with epilepsy. Medication can help gain seizure control.

Our modern environment is a rich source of potentially seizure-triggering visual stimuli. New potentially provocative sources turn-up now and then unexpectedly.

Whether or not a photosensitive seizure happens is also influenced by:

whether the eyes are open, closed or closing at the time of the stimulation

the speed or flicker of the flashing light or movement of the geometrical pattern

the contrast and brightness of the stimuli – in general, with brighter stimuli and strong contrasts in colour, the more likely seizures will be induced

how long the stimulation goes for – a seizure is more likely to occur with longer exposure

the colour of the flicker (if any) – red flicker is more provocative and colour oscillating from red to blue

how large and close the screen is – the larger and closer someone is, the more “field of view” it takes up and is more likely to trigger a seizure.

If you find the light is irritating, or makes you feel you may have a seizure, then speak to your boss and see if you can move to a different location at work, or ask if the light can be removed or dimmed. Also, some people with photosensitive epilepsy benefit from wearing tinted glasses such as the Zeiss Z1 blue lens glasses.

Q: Can I drink coffee if I have epilepsy? I heard it might cause seizures.

A: Coffee contains caffeine which is a stimulant found in a variety of foods and beverages, such as soft drinks, high energy drinks, tea, coffee, and chocolate. It can also be found in some supplements and medications, including some diet pills, antihistamines and decongestants. Be aware that some high energy and soft drinks contain more caffeine than a strong coffee.

Excessive amounts of caffeine can cause an increase in seizures in some people. In addition, caffeine may interfere with antiepileptic medications, and affect sleep patterns.

Some stimulant drinks or high energy drinks have other substances, like guarana. Guarana is a natural caffeine source and a stimulant. It is a common ingredient in high energy drinks and herbal ‘weight loss’ teas and can combine with adrenaline to produce an even stronger stimulant effect.

Any substance that is a stimulant should be avoided or taken with care and moderation, as they are more likely to increase the risk of seizures. It’s hard to know exactly how much caffeine is a problem, as its effects on the body vary from person to person. The rough guideline for the average person is to drink (or eat) less than 600 mg per day – around four cups of coffee, or five or six cups of tea. This would probably be less for someone with epilepsy. So limit your coffee intake to two or three cups a day at most. If you also drink soft drink, this should be included in this quota.